The RACGP has released a report outlining minimum requirements for clinical software used in general practice.

SUMMARY:

Minimum requirements for general practice clinical information systems to improve usability report identifies and details a number of key CIS functions and roles, and provides recommendations focused on improving usability in the collection, management, use and sharing of information. The reports was developed in collaboration with software developers and the Australian Digital Health Agency.

Here is some information on the Johns Hopkins ACG tool that were are using at Gold Coast PHN. The 2nd attachment is a report we produce for practices using their data mapped to ICPC2+ and run through the ACG. This has a practice's data in it. This report gets refreshed with new data every 15 mins ( we currently extract data every minute from our test practices). We have this report, data quality reports and reports that re-identify patients back in the practice with certain risk factors who don't have treatments in place

I have received the invitation to the teleconference at 1230 Brisbane time on Wednesday 13th March.

Has any poll been conducted of everybody in this group to find the best day and time for these meetings? GPs and other clinical people in the group have fixed commitments to see patients, which could make it difficult or impossible for different clinically active members to participate in these teleconferences, depending on the days and times of the teleconferences. Since this is a Clinical Working Group, I think that is important to maximise participation by clinically active people in the group.

One strategy to enable as many members of the group to participate as possible is to study the usual availability of members as reported in a poll, and then to vary the days and times of the meetings so that members who can't participate in one meeting can participate in the next meeting that is on a different day and time.

Unfortunately for this next scheduled meeting (March 13) there is little flexibility in most diaries, and this means this meeting really can't be moved... else everything else gets pushed back as well.

But your suggestion for Doodle Polls for ongoing, regular, meetings will be actioned.

We'll also make sure that CWG participants have visibility of intended agenda items for each of those meetings so they can self-select in (or not) as their own availability allows.

Thanks Donna. I agree with Oliver that it is vital to have clinician input consistently at this early stage. A poll moving forward would be great. Please post if there is any input that we provide prior to the March 13th meeting.

Less relevant .. it rarely matters what day or week or month, as time goes on (except 3rd party eg insurers, but those details are readily found in the text)"

The exact date of some events is important. The date on which appendicitis or a ruptured colonic diverticulum was diagnosed matters, because for some or most patients with these conditions emergency surgery is needed, and these conditions and the treatment for them can have significant consequences and complications that occur sometimes immediately afterwards and that can persist for some time. The exact date of an event such as 'Death of partner' or 'Death of child' matters because of the profound effects that such events have, including anniversary phenomena that are harder to recognise if only the year of that event has been recorded.

ACRRM says:

"No where on current system to record "vaccinations up to date" without actually having all the nitty gritty info". I would find it hard to do anything useful with an entry that said: "vaccinations up to date", because this would not tell me whether it had been confirmed that an adult patient had received all of the childhood immunisations that were available during that person's early years. In a 20 year old, would reading "vaccinations up to date" in July tell me that the patient had received the influenza vaccine during the preceding months of that year? In a 50 year old, would "vaccinations up to date" tell me that the patient had had a pertussis booster within the previous ten years?

Most GPs and practice nurses have received no instruction or guidance about what they could or should record in this field, or how they should do it. In most practices there has been no discussion at a practice meeting about this. Most would not have read the help files for their clinical software package or watched any video tutorials.

Are entries in this field intended to record what the patient states as the reason(s) for the consultation? My experience is that in most cases what is recorded by the health professional is what the health professional assumes to be the patient’s reason for the consultation.

If the appointment was made at the direction or request of a GP or practice nurse, this fact and the reason(s) should be explicitly stated in this field.

In my experience, what is recorded is often misleading and often a statement of what the patient or the health professional expects or wants to happen during the consultation or to be the outcome of the consultation, rather than a statement of a need, want, issue, concern or problem. Entries such as ‘repeat prescription’ or ‘medical certificate’ are not reasons for requesting a consultation. In the first case, the actual reason is that the patient is running out or has run out of one more medicines that she or he has been using and that she or he believes or has been told might or will need to be re-prescribed. In the second case, the actual reason for seeking the consultation is that the patient is unable or unwilling to work or to fulfill some other obligation.

Should 'Lifestyle factors' include exercise, diet and the number, type and condition of the patient's teeth and adequacy of the patient's dental care? All of these are important determinants of health. Dental status has been largely neglected and ignored by the medical profession, despite dental problems being well known to be the fifth most common reason for admission to hospital.

Thanks Oliver.... will note this for consideration/inclusion. Do you (yourself) currently have the ability to capture store this info - particularly dental related data? Would you as a receiving clinician be grateful just to obtain that info in free text (synopsis/narrative or similar?) I guess I'm asking a sufficient/necessary question and about form and format? Hope to see you April 17. Donna

My practice uses Zedmed, which does not have any structured way to record and update any of these three kinds of information.

I have a feeling that either or both Best Practice and/or MedicalDirector might have a module in which to record the patient's diet and/or exercise. I will have to look when I am next at my Uni job where I have those software packages installed for research purposes.

I am not aware of any clinical software packages used in general practice providing a dental status module, but it is possible that one or more of them does so. I can check Best Practice and/or MedicalDirector later in the week. Users or vendors of those packages who read this discussion in the meantime might be able to tell you.

Dental and dental care status is important to record and update not only because research has confirmed that good dental status makes a big difference to health, but also because many people have little or no access to dental care.